W15_03 substance abuse 2

Question 1

what are the 2 major neurotransmitter systems affected in alcohol?

Answer 1

GABA - cns inhibition;
glutamate - CNS excitation

Question 2

what are 2 main acute (6-24h) alcohol withdrawal symptoms?

Answer 2

tremor;
diaphoresis

Question 3

note: hallucinations (mostly visual) and seizures (grand mal) can occur after alcohol withdrawal too

Answer 3

8-24 hours, 24-48 hours respectively

Question 4

when do delirium tremens occur in alcohol withdrawal?

Answer 4

72-92 hours after last drink;
tachycardia, tremor, diaphoresis, fever, disorientation, global confusion, hallucinations, psychomotor agitation;
mortality up to 30-40%

Question 5

what’s the medical treatment of choice for those in alcohol detox?

Answer 5

benzodiazepines

Question 6

what are the 5 stages of treatment?

Answer 6

identification;
intervention;
detoxification;
rehab;
prevention of relapse

Question 7

recall the CAGE questionnaire

Answer 7

feel the need to cut down?
Annoyed by criticism on drinking?
Guilty?
Eye openers in the morning?

Question 8

what’s the binge drinking question?

Answer 8

in the past year, how many occassions have you have 5+ drinks (men) or 4+ drinks (women) in one day?

Question 9

what are the limits for “too much” drinking?

Answer 9

women: 10/week;
men: 15/week

Question 10

what is naltrexone?

Answer 10

opioid antagonist for alcohol withdrawal

Question 11

what is acamprosate?

Answer 11

enhances GABA system and modulates glutamate to relieve sub-acute withdrawal of alcohol

Question 12

what’s disulfiram?

Answer 12

inhibits acetaldehyde dehydrogenase, so any alcohol causes hangover effects quickly

Question 13

which receptors do opiods act on?

Answer 13

endorphin (mu) receptors

Question 14

name some opioid drugs

Answer 14

heroin;
morphine;
codeine;
oxycodone;
hydromorphone;
fentanyl

Question 15

note: common pain conditions usually don’t need opiates, so try to find others

Answer 15

ok

Question 16

what are symptoms of opioid withdrawal?

Answer 16

flu-like symptoms;
myalgia, chills, vomiting

Question 17

note: methadone can relieve withdrawal symptoms without inducing sedation or euphoria

Answer 17

ok

Question 18

how does buprenorphine work?

Answer 18

partial agonist that displaces other opioids - ceiling effect so can’t overdose

Question 19

note: cannabis is discussed

Answer 19

ok

Question 20

how does cocaine work?

Answer 20

blocks presynaptic uptake of dopamine, norepinephrine, epinephrine

Question 21

what’s GHB?

Answer 21

metabolite of GABA;
sedative

Question 22

how does MDMA work?

Answer 22

stimulates release of serotonin

Question 23

what are some psychotherapies for substance use?

Answer 23

motivational interviewing;
cognitive behavioural therapy;
12-step facilitation/AA/NA;
contingency management;
family therapy